Higher Counts Research Articles

A higher JAK2V617F allele burden may be a risk factor for hemorrhagic events in younger patients with polycythemia vera

ABSTRACT Objectives: Hemorrhagic events are a rare but potentially fatal complication in patients with polycythemia vera (PV). Methods: We analyzed the characteristics of hemorrhagic events in 267 patients with PV. Results: A median follow-up of 4.8 years revealed that 23 (8.6%) hemorrhagic events occurred. Significantly more hemorrhagic events occurred in younger patients aged below 60 years (n = 72) than in older patients aged 60 years or above (n = 191) (n = 12 [16.7%] vs. n = 11 [5.8%], respectively, P = 0.012). In univariate analysis among the younger patients, white blood cell (WBC) count ≥ 15 × 109/L (hazard ratio [HR] = 7.746, 95% confidence interval [CI] 2.082-28.830, P = 0.002), palpable splenomegaly (HR = 5.629, 95% CI 1.193–26.550, P = 0.029), and JAK2V617F allele burden ≥ 80% (HR = 22.850, 95% CI 2.885–181.00, P = 0.003) were associated with an increased risk of hemorrhagic events. In multivariate analysis, JAK2V617F allele burden ≥ 80% (HR = 9.394, 95% CI 1.046–84.380, P = 0.046) was a significant risk factor. Conclusions: There is an increased risk of hemorrhagic events after diagnosis in younger PV patients with a high JAK2V617F allele burden, high WBC count or palpable splenomegaly. It is important to consider treatment options that aim to avoid hemorrhagic events by reducing the JAK2V617F allele burden in younger PV patients.

Cerebral microbleeds linked to structural network disruption and cognitive impairment in white matter hyperintensities.

This study aims to explore the relationship between the cerebral microbleeds (CMBs) and white matter structural network in patients with white matter hyperintensities (WMHs), and the correlation with the cognitive impairment. One hundred and fifty-eight participants with WMHs underwent 3.0 T magnetic resonance imaging scans and neuropsychological assessment. The grouping method included count grading with categories: non-CMBs (n-CMBs), CMBs < 5, and CMBs ≥ 5. Additionally, the distribution of CMBs was considered, distinguishing between strictly lobar CMBs (SL-CMBs) and deep or infratentorial CMBs (DI-CMBs). Diffusion tensor imaging was employed to construct the white matter structural network for each participant. Subsequently, we analyzed the correlations between the topological parameters of network and cognitive performance in individuals with CMBs. Compared with n-CMBs group, both CMBs ≥ 5 and DI-CMBs participants exhibited a significant decreased in global efficiency and increased in characteristic path length. Moreover, in the nodal network metrics, the CMBs ≥ 5 showed the left middle occipital gyrus (MOG.L) of nodal efficiency and nodal shortest path correlated with SCWT-A and MMSE, while in the DI-CMBs groups, the left cuneus (CUN.L) of nodal shortest path correlated with SCWT-A. However, there were no significant neuropsychological correlations observed in the SL-CMBs and CMBs < 5 groups. In this study, patients with a high count (≥5) of CMBs or DI-CMBs are associated with disruptions in the microstructure of the white matter structural network, partially impacting the visual network of occipital lobe and affecting the cognitive function of information processing speed and attention.

Large-scale genome-wide association studies identified causal relationship between multiple blood biomarkers and risk of acute pancreatitis.

Observational studies have shown that there is a connection between blood biomarkers and the occurrence of acute pancreatitis (AP). Nevertheless, the causal relationships are still not clear. The purpose of this study was to evaluate causal association between biomarkers and AP. A bidirectional two-sample Mendelian randomization (MR) analysis was applied to investigate the causal association between blood biomarkers and AP. Summary statistics obtained from genome-wide association studies were utilized for this analysis. The primary statistical approach employed was the inverse variance weighted (IVW) method, complemented by sensitivity analyses aimed at assessing heterogeneity and pleiotropy. Furthermore, a multivariable MR (MVMR) analysis was performed to adjust for confounders. A total of 11 red blood cell (RBC) traits, 6 white blood cell traits, platelet count, and 30 blood biomarkers were analyzed in this study. Genetically predicted RBC count (IVW odds ratio [OR]=1.144, P=0.004), the high light scatter reticulocyte count (HLSR) (OR=1.127, P=0.022), blood glucose (BG) (OR=1.480, P=0.019), and leptin (OR=1.234, P=0.050) were suggestively associated with an increased risk of AP. Reverse MR analysis showed no causal effect of AP on RBC, HLSR, BG, and leptin (IVW P>0.05). Sensitivity analyses and MVMR analysis still supported the earlier causality. Our findings provide evidence of a suggestive association between RBC count, HLSR, BG, and leptin with an increased susceptibility to AP. These findings aid in our comprehension of the cause of AP and may be used as potential prognostic markers or predictors of severity with AP.

Hematological Changes in Newly Diagnosed Pulmonary Tuberculosis Patients on Standard Anti-TB Treatment Regimen and their Influence on Smear Conversion

Pulmonary tuberculosis (PTB) mortality remains high despite the availability of effective anti-TB therapy. Disease and treatment-associated hematological derangements at diagnosis and during therapy might contribute to this high TB mortality rate. This paper aims to determine hematological changes in newly diagnosed pulmonary tuberculosis patients on standard anti-TB treatment regimen and their influence on smear conversion. The study adopted a longitudinal design in which 55 newly diagnosed HIV negative PTB patients were followed up to the fifth month of anti-TB therapy. Blood samples (5ml) were collected for diagnosis during the second and fifth months and analyzed using automated HumaCount 5D hematology analyzer. Data was analyzed using Kruskal-wallis test with Dunn’s multiple comparisons test in Graph-Pad prism version 6.0. Throughout therapy, there was a statistically significant time-dependent decrease in median total white blood cell counts from 6.82x103/ uL at diagnosis to 5.87x103/ uL at the fifth month (P=0.0358). This decrease in total WBC count was majorly driven by significant decrease in the neutrophil numbers from 4.31x103/ uL at diagnosis to 2.97x103/ uL at the fifth month. The proportion of patients who had anemia at the fifth month of treatment increased compared to the second month post intensive phase. There was also a significant decrease in MCV, MCH and MCHC at the second month compared to diagnosis. Moreover, the median platelet count, MPV, PDW and PCT% decreased from 314x103/ uL, 8.9 fL, 10.4 fL and 0.273 at diagnosis to 232x103/ uL, 10.15 fL, 12.5 fL and 0.235 at the fifth month, respectively. High WBC count, high platelet count, low lymphocyte count and low HGB at the end of month two of therapy were shown to increase the likelihood of sputum non-conversion (OR-2.42 (95% Ci 2.07-2.82)), (OR-1.5 (95% Ci 1.01-2.22)), (OR-1 (95% Ci 1-1)) and (OR-2.58 (95% Ci 1.68-3.95)), respectively (P&lt;0.05). A significant number of PTB patients presented with anemia, thrombocytosis and leukocytosis. The proportion of patients with anemia increased over time. The study recommends screening for hematological abnormalities in patients for tailored patient interventions for better clinical outcomes.

Investigation of thunderstorm characteristics with severe lightning events over NE region of India

Abstract. The north eastern region (NER) of India is among the hotspot regions for thunderstorm events leading to substantial loss of lives and properties every year. A reliable thunderstorm early warning system can prevent these losses. As these events are highly dynamic, prediction becomes equally challenging. Diagnostic studies of such events could provide more understanding of lightning and storms over a region which could then be used as input for the prediction of such events. Improving the efficiency of the prediction of associated meteorological parameters could improve the prediction of thunderstorm. In this study, two thunderstorm events have been identified with high lightning flash counts, using observations from the INSAT-3D satellite and lightning detection sensors. These observations revealed that one of the events was caused by a cloud system that originated elsewhere and travelled over the area of impact while the other event was an isolated convective system that occurred over a small region. The characteristic features of thunderstorms, like vertical wind velocity, cloud ice water content, relative humidity, cloud fraction and radar reflectivity, etc. were simulated using the WRF model. These simulations were validated with the ERA-5 reanalysis data and observations from Radar and satellite data. Validation results suggest that the WRF model could predict these features associated with thunderstorm events quite reliably. The study helped to improve the severe weather warning over NER of India and the stakeholders are trained on effective utilization of such warning.

Recovery of clinically relevant multidrug-resistant Klebsiella pneumoniae lineages from wastewater in Kumasi Metropolis, Ghana.

Antimicrobial resistance (AMR) is under-monitored in Africa, with few reports characterizing resistant bacteria from the environment. This study examined physicochemical parameters, chemical contaminants and antibiotic-resistant bacteria in waste stabilization pond effluents, hospital wastewater and domestic wastewater from four sewerage sites in Kumasi. The bacteria isolates were sequenced. Three sites exceeded national guidelines for total suspended solids, biochemical oxygen demand, chemical oxygen demand and electrical conductivity. Although sulfamethoxazole levels were low, the antibiotic was detected at all sites. Multi-drug-resistant Klebsiella pneumoniae and Pseudomonas aeruginosa were isolated with multi-locus sequence typing identifying K. pneumoniae strains as ST18 and ST147, and P. aeruginosa as ST235, all of clinical relevance. A comparison of ST147 genomes with isolates from human infections in Africa showed remarkable similarity and shared AMR profiles. Thirteen of the twenty-one plasmids from ST147 harbored at least one AMR gene, including blaCTX-M-15 linked to copper-resistance genes. Our study demonstrated high bacterial counts and organic matter in the analysed wastewater. The recovery of clinically significant isolates with multiple antibiotic and heavy metal resistance genes from the wastewater samples raises public health concerns.

A single-layer dense convolutional reversible residual network for bearing fault diagnosis based on differential local adaptive

Abstract For the cross-domain fault diagnosis of industrial bearings under different working conditions and noise, most current domain adaptation methods in transfer learning only focus on either marginal distribution alignment or conditional distribution alignment. They fail to adequately combine discriminative and global distribution information. Furthermore, the majority of models have a very high parameter count and memory utilization, which makes it challenging to use them in real-world industrial situations. Therefore, a single-layer densely connected reversible residual network based on differential local adaptation is proposed. This network is more competitive in industrial applications than other fault diagnosis models since it not only uses less memory and has fewer parameters, but it also shows superior cross-domain fault diagnostic capacity in noisy situations. Additionally, to extract discriminative and global domain-invariant features, a domain adaptation module is created that takes into account local and global data distributions differently. Multiple transfer tasks and two distinct datasets are used to validate the model. Comparative tests reveal that the suggested model uses less memory and requires fewer parameters to attain good accuracy and transferability.

Performance Characteristics of a New Generation 148-cm Axial Field-of-View uMI Panorama GS PET/CT System with Extended NEMA NU 2-2018 and EARL Standards.

The uMI Panorama GS PET/CT system is a new long-axial-field-of-view scanner featuring high sensitivity, time-of-flight (TOF) resolution, spatial resolution, and count rate performance. The aim of this study is to assess the PET system on the basis of the National Electrical Manufacturers Association (NEMA) NU 2-2018 and European Association of Nuclear Medicine Research Limited (EARL) standards. Methods: Spatial resolution, count rate performance, sensitivity, accuracy, image quality, TOF resolution, and coregistration accuracy were evaluated following the NEMA NU 2-2018 standard. Additional experiments included energy resolution, 200-cm-long line sources for sensitivity, a 175-cm-long scatter phantom for count rate and TOF resolution, as well as the compliance with the EARL guideline. Moreover, an 18F-FDG PET patient study was reconstructed with various frame durations. Results: The PET system achieved sub-3-mm transaxial and axial spatial resolutions at a 1-cm radial offset. The sensitivities with the 70-cm-long and 200-cm-long line sources were observed to be 176.3 and 90.8 kcps/MBq, respectively, at the center of the field of view. The noise-equivalent count rates (NECRs) of the 70-cm-long and 175-cm-long scatter phantoms were measured to be 3.35 Mcps at 57.57 kBq/mL and 2.24 Mcps at 33.27 kBq/mL, respectively. The TOF resolutions for both phantoms were approximately 189 ps at 5.3 kBq/mL and lower than 200 ps below the NECR peaks. The absolute count rate errors of all 34 acquisitions were less than 3% below the NECR peak for the 70-cm-long scatter phantom. With the standard NEMA image quality phantom experiment, the contrast recovery coefficient varied from 68.17% to 94.20% and the background variabilities were all below 2%. The maximum PET/CT coregistration error was 1.33 mm. Regarding EARL compliance, the gaussian filter of 5-mm full width at half maximum could produce acceptable images. The patient data demonstrate visually satisfactory image quality with short frames (less than 1 min). Conclusion: The uMI Panorama GS exhibits spatial resolution and TOF resolution similar to those of the uMI Panorama system (35-cm axial field of view), despite the extended axial field of view. The 148-cm axial coverage, sub-200-ps TOF resolution, high sensitivity, and count rate performances are expected to yield superior image quality and offer new opportunities for various clinical applications.

Mosaic chromosomal alterations (mCAs) in individuals with monoclonal B-cell lymphocytosis (MBL)

MBL is a precursor condition to chronic lymphocytic leukemia (CLL), characterized by monoclonal B-cells in blood. Mosaic chromosomal alterations (mCAs) are a form of clonal hematopoiesis that include gains, losses, and copy-neutral loss-of-heterozygosity of large DNA segments. Both MBL and mCAs have been found to increase the risk of CLL and lymphoid malignancies, and the aim of our study was to investigate how mCAs relate to MBL, which is currently unknown. We analyzed genetic, flow cytometric, and hematologic data from 4632 individuals from the Mayo Clinic Biobank and CLL Database. MBL was detected using flow cytometry and classified as high-count (HC) or low-count (LC) MBL based on clone size. mCAs were detected primarily from whole blood DNA using sensitive SNP-array-based analyses. mCAs commonly altered in CLL (deletion of 6q, 11q, 13q, 17p, and trisomy 12) were specific (>99%) to individuals with MBL and CLL. HC-MBL and LC-MBL individuals were 881-fold and 8-fold, respectively, more likely to harbor CLL-associated mCAs than those without MBL. The cell fraction bearing these mCAs typically exceeded the B-cell fraction, suggesting their origin prior to the B-cell lineage. Integrating genetic and blood count data enabled detecting HC-MBL with high specificity in a biobank sample. These results quantify the contribution of mCAs to MBL and could enable large studies of HC-MBL without the need for flow cytometric screening.

Impact of bone marrow nucleated cell subfractions on transplant outcomes in patients with acute lymphoblastic leukemia

ABSTRACT Objectives Our previous study showed that a high pre-transplant nucleated cell count in the bone marrow is associated with increased non-relapse mortality (NRM) and decreased overall survival (OS) in patients with acute lymphoblastic leukemia (ALL) in remission. In this retrospective multicenter study, we aimed to examine the association between nucleated cell subfractions and transplant outcomes using the same patient cohort as our previous study. Methods This study included patients with ALL who underwent their first allogeneic hematopoietic stem cell transplantation (allo-HSCT) between 2010 and 2022. The patients were stratified into high and low cell group levels to compare transplant outcomes using cutoff values for predicting OS in each subfraction determined using receiver operating curves. Results In the cohort of 134 patients, the median values for myeloid, erythroid, monocyte, and lymphocyte series were 16,860/µL (468–229,296), 15,584/µL (34–246,992), 1,446/µL (70–25,296), and 4,215/µL (90–33,856), respectively. Discussion The univariate analysis showed that the groups with high levels of myeloid cells (≥38,000/µL, n = 48), erythroid cells (≥25,000/µL, n = 45), and monocyte cells (≥4,200/µL, n = 44) were all associated with worse 3-year OS and higher NRM than the low-level groups. These findings were confirmed by using multivariate analysis. The high cell count group showed a higher incidence of NRM associated with acute graft-versus-host disease or immunological disorders. Conclusion High myeloid, erythroid, and monocytic cell levels in the bone marrow before allo-HSCT may independently increase the risk of NRM and reduce OS.

Platelet count has a U-shaped association with mortality in hemodialysis patients

Our previous manuscript showed that thrombocytopenia predicts all-cause mortality in Chinese hemodialysis (HD) patients. Based on the role of platelets in coagulation, clot formation, and systemic inflammation, we speculate that high platelets increase risk of thrombo-embolic events, hence the mortality. However, research evidence is currently lacking. Therefore, we utilized data from a very large international cohort study to explore the association of platelet counts with mortality and cardiovascular (CV) death in hemodialysis (HD) patients. International data from 396 facilities enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 5 (2012–2015) were analyzed. Participants were divided into 3 groups according to their platelet counts (low: <100, normal: 100–300, high: >300*109). Associations between platelet counts and all-cause and CV mortality were analyzed using Cox regression, adjusted for confounders. There were 13,631 patients with median age of 65 years old. Males accounted for 61.2%. Mean platelet count was 205*109/L overall and ranged from 173 *109/L in China to 227 *109/L in Sweden. Overall, 2,348 (17.2%) patients died and 1017 (7.5%) died from CV disease. Both low (HR:1.48, 95% CI 1.21–1.80, p < 0.001) and high (HR:1.17, 95% CI 1.00- 1.35, p = 0.044) platelet counts were associated with higher all-cause mortality after adjustment for covariates; results for CV death were consistent. Platelet count has a U-shaped association with all-cause and CV mortality in HD patients, and thus may be used as an outcome predictor that is readily available among HD patients.

Expanding the landscape of systemic sclerosis-related autoantibodies through RNA immunoprecipitation coupled with massive parallel sequencing

ObjectivesSystemic sclerosis (SSc)-related autoantibodies are widely used diagnostic and prognostic biomarkers. This study aimed to develop a new assay for detecting anti-ribonucleoprotein autoantibodies in SSc based on RNA immunoprecipitation (RNA IP) coupled with massive parallel sequencing. MethodsSerum samples and clinical data were collected from 307 SSc patients. Among these, 57 samples underwent analysis using a new protocol that combines RNA IP with massive parallel sequencing (RIP-Seq). Filtering strategies and statistical outlier detection methods were applied to select RNA molecules that could represent novel ribonucleoprotein autoantigens associated with SSc. ResultsAmong the 30,966 different RNA molecules identified by RIP-Seq in 57 SSc patients, 197 were ultimately selected. These included all RNA molecules previously identified by RNA IP, which were found to exhibit high counts almost exclusively in samples positive for the autoantibodies associated to the corresponding RNA molecule, indicating high sensitivity and specificity of the RIP-Seq technique. C/D box snoRNAs were the most abundant RNA type identified. The immunoprecipitation patterns of the detected C/D box snoRNAs varied among patients and could be associated with different clinical phenotypes. In addition, other ribonucleoproteins were identified, which could be potential targets for previously undescribed SSc-related autoantibodies. These include H/ACA box snoRNPs, vault complexes, mitochondrial tRNA synthetases, and 7SK snRNP. ConclusionA novel RIP-Seq assay has been developed to detect autoantibodies targeting ribonucleoprotein complexes in SSc patients. This method successfully identified RNA molecules associated with ribonucleoproteins known to be targeted by SSc-related autoantibodies, validating both the assay and the analysis strategy. Additionally, this approach uncovered RNA molecules associated with ribonucleoproteins that were not previously identified as targets of SSc patients’ sera, suggesting potential new autoantibody candidates in this disease.

Soft fingers with variable stiffness for space gripping tasks: An assessment

The miniaturization of satellites and the problem of uncontrolled space debris demand highly flexible methods for space grippers. Soft grippers have surged as viable alternatives to overcome the limitations of traditional rigid grippers, such as lack of adaptability and dexterity. Although existent models have shown promising features, most have a high part count or make use of actuation systems that are inadequate for space, like pneumatic pumps or temperature-dependent materials. This work introduces novel designs of soft fingers that address the inherent challenges of grasping objects in space while overcoming these limitations. The proposed fingers use compliant structures based on several geometries of metamaterials. A detailed compliance and compressibility analysis is conducted using finite element methods to highlight the performance and behavior of each proposed design. Prototypes were fabricated, and their ability to exhibit different modes of actuation (variability in stiffness) by tendon compression was confirmed. The most apt design was selected and showcased in a three-fingered gripper to demonstrate the ability to grasp a given set of geometries with different sizes.

Examination of Salmonella Prevalence in Pigs Through Rye-Based Feeding and Coarser Feed Structure Under Field Conditions.

Salmonellosis is the second most commonly occurring bacterial zoonosis in Germany. Rye in pig feeding offers new possibilities for addressing that issue due to its high content of non-starch polysaccharides (NSPs). These are fermented in the intestinal tract to specific fermentation products, which seem to have bacteriolytic effects against Salmonella. A coarse feed structure can display synergistic effects. Seven conventional pig fattening farms increased the rye content (40%-70%) while limiting the amount of fine particles (maximum of 20% ≤0.25mm). Samples from pigs were tested for Salmonella antibodies and compared with samples from 167 farms without any changes to the feed. Rye-based diets had a significant (p<0.05) impact on Salmonella antibody (percentage optical density [OD%]) detection. In this study, it became apparent that significantly fewer positive OD% values could be detected due to the increase in rye compared to farms that did not change the feed (Farm 6 P0: 35.45±36.18; P1: 15.48±16.98; P2: 9.36±8.17). An elimination of Salmonella could not be achieved, but especially farms with high antibody counts were able to strongly reduce those in both phases consecutively (Farm 5 P0: 35.17±35.53; P1: 18.56a±20.96; P2: 13.38a±18.99). That was different on farms without adapted feeding, where an increase in Salmonella antibodies was observed (P0: 17.38±22.21; P1: 20.12±25.39; P2: 18.12±25.44). By increasing the proportion of rye and limiting the proportion of fine particles in the feed, Salmonella antibodies (OD% values) in meat juice and blood can be significantly reduced, especially on farms with an initially high incidence of Salmonella. If that is implemented in feeding across the board on farms, an improvement in food safety and a decreased risk of zoonosis can be expected.

A method for recognizing abnormal behaviors of personnel at petroleum stations based on GTB-ResNet

PurposeThe abnormal behaviors of staff at petroleum stations pose significant safety hazards. Addressing the challenges of high parameter counts, lengthy training periods and low recognition rates in existing 3D ResNet behavior recognition models, this paper proposes GTB-ResNet, a network designed to detect abnormal behaviors in petroleum station staff.Design/methodology/approachFirstly, to mitigate the issues of excessive parameters and computational complexity in 3D ResNet, a lightweight residual convolution module called the Ghost residual module (GhostNet) is introduced in the feature extraction network. Ghost convolution replaces standard convolution, reducing model parameters while preserving multi-scale feature extraction capabilities. Secondly, to enhance the model's focus on salient features amidst wide surveillance ranges and small target objects, the triplet attention mechanism module is integrated to facilitate spatial and channel information interaction. Lastly, to address the challenge of short time-series features leading to misjudgments in similar actions, a bidirectional gated recurrent network is added to the feature extraction backbone network. This ensures the extraction of key long time-series features, thereby improving feature extraction accuracy.FindingsThe experimental setup encompasses four behavior types: illegal phone answering, smoking, falling (abnormal) and touching the face (normal), comprising a total of 892 videos. Experimental results showcase GTB-ResNet achieving a recognition accuracy of 96.7% with a model parameter count of 4.46 M and a computational complexity of 3.898 G. This represents a 4.4% improvement over 3D ResNet, with reductions of 90.4% in parameters and 61.5% in computational complexity.Originality/valueSpecifically designed for edge devices in oil stations, the 3D ResNet network is tailored for real-time action prediction. To address the challenges posed by the large number of parameters in 3D ResNet networks and the difficulties in deployment on edge devices, a lightweight residual module based on ghost convolution is developed. Additionally, to tackle the issue of low detection accuracy of behaviors amidst the noisy environment of petroleum stations, a triple attention mechanism is introduced during feature extraction to enhance focus on salient features. Moreover, to overcome the potential for misjudgments arising from the similarity of actions, a Bi-GRU model is introduced to enhance the extraction of key long-term features.

The impact of daily step count with mobile health apps on clinical outcomes among general population

Abstract Background/Introduction Numerous studies have investigated the correlation between daily step count and the reduction of all-cause mortality and cardiovascular events. However, the optimal daily step count for the general population remains controversial. Purpose This study aims to assess cardiovascular risk based on individual step counts using a large cohort that includes step count data from mHealth Apps (Kencom), health checkups databases, and Japanese insurance claims databases. Methods We analyzed data from 85,204 users registered with Kencom between January 2016 and September 2021. The mean step count during one year before and after baseline data collection was used to define each individual's step count. We divided participants into low (N=45,539) and high (N=39,665) step count groups based on their mean step counts. Additionally, we categorized users into five groups based on their step counts (&amp;lt;4000; 4000-5999; 6000-7999; 8000-9999; and ≥10000) to evaluate cardiovascular events. The primary outcome was the occurrence of cardiovascular events, including myocardial infarction, stroke, angina pectoris, heart failure, and atrial fibrillation, as classified by the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). The cumulative incidence was estimated over 5 years. Results The high step count group was generally younger and predominantly male. No significant differences in cardiovascular risk factors such as hypertension, dyslipidemia, diabetes mellitus, and current smoking status were found between the two groups. Stratifying baseline characteristics by step count revealed significant differences among the five groups, with the exception of sex. The cumulative incidence of cardiovascular events was significantly lower in the high step count group compared to the low step count group (6.5% vs. 7.5%, log-rank P=0.005, Figure 1). After adjusting for confounding factors, the risk reduction of the high step count group remained significant (HR: 0.92, 95% CI: 0.87-0.98, P=0.005). Among the five step count groups, the incidence of primary outcome significantly differed, with only Group 5 (≥10000 steps) showing a significant reduction in the risk of cardiovascular events compared to Group 1 (&amp;lt;4000 steps) after adjustment (HR: 0.87, 95% CI: 0.77-0.99, P=0.03). Subgroup analyses based on sex indicated that the risk reduction was significant in males in Group 5 but not in females. Conclusion The risk of cardiovascular events was higher in the low step count group compared to the high step count group. After adjusting for confounders, only the highest step count group (≥10,000 steps/day) showed a significant reduction in cardiovascular event risk compared to the lowest step count group.

High eosinophil counts aid in diagnosing Kawasaki disease in febrile children

Abstract Background Several recent studies have validated the newfound significance of elevated eosinophils in Kawasaki disease (KD). However, this finding was not incorporated into the suggested laboratory criteria outlined by the Kawasaki Disease Committee of the American Heart Association for assessing children with incomplete KD. Purpose We aimed to determine the potential benefits of including eosinophil levels in the laboratory evaluation of KD. Methods A retrospective cohort study involved 77,934 febrile children (FC, not KD) and 1,970 subjects diagnosed with KD. Participants were recruited from four hospitals, comprising two medical centers and two regional hospitals. The AHA recommends specific laboratory tests—white blood cell count, hemoglobin, platelet count, ALT levels, albumin, and urinalysis—for evaluating incomplete KD in children with a higher CRP than 30mg/dL. The first four items are standard blood assays. Additionally, we introduced high eosinophil counts as a new diagnostic criterion for identifying children with KD. Results All these five laboratory findings (anemia for age defined as below the 5th percentile), platelet count &amp;gt;450,000/mm3, white blood cell&amp;gt;15,000/mm3, ALT&amp;gt;40 U/L, and eosinophil count &amp;gt;190/mm3) are significantly different between KD children and FC. The proportion of having these features is higher in KD children than in FC (19.3% vs. 8.0% in anemia for age, 20.5% vs. 10.3% in thrombocytosis, 37.0% vs. 18.1% in leukocytosis, 45.7% vs. 5.8% in elevated ALT, and 62.6% vs. 29.3% in high eosinophils). Elevated eosinophil counts are most commonly associated with KD among these five parameters. Furthermore, when incorporating the parameter of elevated eosinophil counts, the proportion of KD children with at least two abnormalities rose from 35.4% to 60.7%. In a subgroup analysis of children with KD presenting at least two abnormalities, the proportion rose from 38.7% to 63.5% in the high CRP group (≧ 3.0 mg/L) and 21.6% to 49.0% in the low CRP group (&amp;lt; 3.0 mg/L), respectively. Conclusions Higher eosinophil counts are vital markers in KD children. This aids in the identification of additional potential KD cases, especially in those exhibiting low CRP levels.

Impact of neutrophil-to-lymphocyte ratio on clinical outcomes in patients with or without chronic kidney disease undergoing percutaneous coronary intervention

Abstract Background Neutrophil-to-lymphocyte ratio (NLR) has recently emerged as inexpensive inflammatory biomarker associated with worse cardiovascular outcomes. However, little is known about its role in risk stratification of patients with both chronic kidney disease (CKD) and coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). Purpose We aimed to evaluate the clinical impact of baseline NLR in patients with and without CKD undergoing PCI. Methods We retrospectively evaluated all consecutive patients undergoing PCI between 2012-2022 in a large tertiary US center. We excluded patients without available NLR and those who were deemed to have active hematological or infective diseases, including patients with extremely low or high lymphocyte and neutrophil counts or with hs-CRP above 10 mg/L. Quartiles of NLR were derived in the overall population and patients were stratified according to presence of CKD (eGFR &amp;lt; 60 ml/min). Within each group, we estimated the risk of adverse events using the lowest NLR quartile as reference. The primary endpoint was 12-month incidence of major adverse cardiovascular events (MACE), defined as the composite of all-cause death, myocardial infarction, or stroke. Secondary endpoints included incidence of clinically relevant bleeding and contrast-associated acute kidney injury (CA-AKI), defined as ≥ 0.3 mg/dL or ≥ 50% serum creatinine increase from baseline. Results A total of 7,287 patients were included in the analysis; of these 2,008 (27.6%) had CKD and 5,279 (72.4%) did not. CKD patients (mean eGFR 40.8±16.1 ml/min) were older, had more comorbidities, and presented with higher hs-CRP levels and a greater estimated risk of CA-AKI. Overall, patients with elevated NLR had more severe CAD and underwent more complex PCI. In CKD patients, incidence of adverse events increased stepwise and those in the 4th NLR quartile had the highest adjusted risks of MACE (HRadj 1.86, 95% CI 1.12-3.08; P=0.012), all cause death (HRadj 2.44, 95% CI 1.18-5.05; P=0.003) and bleeding (HRadj 1.74, 95% CI 1.07-2.84; P=0.002) at 1 year, as compared to those in the lowest quartile (Table 1). In patients without CKD, MACE and all-cause death incidences were numerically higher in the 4th quartile but risk estimates were no longer statistically significant after adjustment. The overall incidence of CA-AKI was much greater in the CKD group. When compared to the lowest quartile, patients in the 4th NLR quartile showed a trend for higher risk of CA-AKI in CKD group, while they had a significant increased risk in non-CKD group (Figure 1). Conclusions Elevated NLR is strongly associated with higher risk of MACE and all-cause mortality in CKD patients. Conversely, the risk of bleeding and CA-AKI is increased with elevated NLR in both CKD and non-CKD patients. Thus, NLR may further inform risk stratification of CKD patients undergoing PCI.

Impact of neutrophil-to-lymphocyte ratio on clinical outcomes in patients with acute or chronic coronary syndrome undergoing percutaneous coronary intervention

Abstract Background Neutrophil-to-lymphocyte ratio (NLR) has recently emerged as an inflammatory biomarker associated with atherosclerosis and cardiovascular events. However, its role in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remains unclear. Purpose We aimed to evaluate the clinical impact of baseline NLR in patients undergoing PCI for acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). Methods We retrospectively evaluated all consecutive patients undergoing PCI between 2012-2022 in a large tertiary US hospital. We excluded patients for whom NLR was not available and those who were deemed to have active hematological or infective diseases, including patients presenting with extremely low or high lymphocyte and neutrophil counts or with hs-CRP above 10 mg/L. Quartiles of NLR were derived in the overall population and patients were stratified according to clinical presentation. Within each group, we estimated the risk of 12-month adverse events using the lowest NLR quartile as reference. The primary endpoint was major adverse cardiovascular events (MACE), defined as the composite of all-cause death, myocardial infarction (MI), or stroke. Secondary endpoints were MACE individual components and any periprocedural or post-discharge clinically relevant bleeding. Results A total of 7,201 patients were included in the analysis; of these 3,975 (55.2%) had ACS and 3,226 (44.8%) CCS. Patients in the 4th quartile (NLR &amp;gt; 5.0) were more frequently male, older, and presented more often with chronic kidney disease and complex coronary artery disease. Smoking, diabetes and history of CAD, as well as triglycerides, LDL, non-HDL and total cholesterol levels were lower in the 4th NLR quartile. In patients presenting with CCS, the risk of MACE, all-cause death, MI was similar across NLR quartiles, while the risk of bleeding increased stepwise (Figure 1). In patients presenting with ACS, the 4th NLR quartile had the highest adjusted risk of MACE (HRadj 1.82, 95% CI 1.25-2.67; P=0.002), all cause death (HRadj 2.56, 95% CI 1.41-4.66; P&amp;lt;0.001), and bleeding (HRadj 1.82 95% CI 1.25-2.63, P&amp;lt;0.001) at 1 year, as compared to the lowest quartile (Table 1). Conclusions Among patients undergoing PCI, elevated NLR is strongly associated with risk of MACE and all-cause mortality in patients presenting with ACS but not in those with CCS. Conversely, the risk of bleeding was augmented with higher NLR in both ACS and CCS patients undergoing PCI. In this setting, NLR may inform risk stratification at the time of PCI.

Initial results of the Hyperion IIDPET insert for simultaneous PET-MRI applied to atherosclerotic plaque imaging in New-Zealand white rabbits.

In preclinical research, in vivo imaging of mice and rats is more&#xD;common than any other animal species, since their physiopathology is very well-&#xD;known and many genetically altered disease models exist. Animal studies based on&#xD;small rodents are usually performed using dedicated preclinical imaging systems&#xD;with high spatial resolution. For studies that require animal models such as mini-&#xD;pigs or New-Zealand White (NZW) rabbits, imaging systems with larger bore&#xD;sizes are required. In case of hybrid imaging using Positron Emission Tomography&#xD;(PET) and Magnetic Resonance Imaging (MRI), clinical systems have to be used,&#xD;as these animal models do not typically fi t in preclinical simultaneous PET-MRI&#xD;scanners.&#xD;Approach. In this paper, we present initial imaging results obtained with the&#xD;Hyperion IID PET insert which can accommodate NZW rabbits when combined&#xD;with a large volume MRI RF coil. First, we developed a rabbit-sized image&#xD;quality phantom of comparable size to a NZW rabbit in order to evaluate the&#xD;PET imaging performance of the insert under high count rates. For this phantom,&#xD;radioactive spheres with inner diameters between 3.95 and 7.86 mm were visible&#xD;in a warm background with a tracer activity ratio of 4.1 to 1 and with a total&#xD;18-F activity in the phantom of 58MBq at measurement start. Second, we performed&#xD;simultaneous PET-MR imaging of atherosclerotic plaques in a rabbit in vivo using&#xD;a single injection containing 18-F-FDG for detection of infl ammatory activity,&#xD;and Gd-ESMA for visualization of the aortic vessel wall and plaques with MRI.&#xD;Main results. The fused PET-MR images reveal 18-F-FDG uptake within an&#xD;active plaques with plaque thicknesses in the sub-millimeter range. Histology&#xD;showed colocalization of 18-F-FDG uptake with macrophages in the aortic vessel wall lesions. &#xD;Significance. Our initial results demonstrate that this PET insert&#xD;is a promising system for simultaneous high-resolution PET-MR atherosclerotic&#xD;plaque imaging studies in NZW rabbits.